Curing disease one appointment at a time: Doctors Without Borders and Twilio

Improving care through appointment reminders

Medecins Sans Frontieres, also known as Doctors without Borders, provides medical humanitarian aid in communities around the World. From emergency response to outbreak control, this organisation of selfless health workers, saves lives with their work. While MSF is best known for springing into action in emergency situations, the organisation spends a lot of time investing in new programs to improve health systems in developing countries.

In 2013, the Epworth Clinic which is supported by MSF, searched for a better way to remind long-term care patients in Zimbabwe of their upcoming appointments. Developers at Random Hacks of Kindness, a global organization that connects technologies with social impact organizations, organized an event that provided the Epworth Clinic the communication solution they needed. Over some months, the civic-minded developers built Twilio-powered app which impacted over 300 tuberculosis patients.

The Epworth Clinic and Zimbabwe’s MSF team

Epworth is situated about 12 kilometres outside Harare, in Zimbabwe. The majority of people who reside in Epworth, live below the poverty line. Epworth is a poor peri urban slum settlement with an estimated population of more than 400 000 people. These conditions contribute to a high rate of HIV and Tuberculosis (TB). The Epworth Clinic currently supports around 10,000 HIV positive patients and up to around 500 TB patients at any one time.

In Zimbabwe around 14% of the population is estimated to have HIV, and Zimbabwe is one of the 22 high TB prevalence countries. With a long-term diagnosis, patients need regular check-ups and a consistent regimen of medication. But keeping on-top of appointments and medication can be challenging for patients in this setting, just like any other. At the clinic, one in seven TB patients drop treatment before attending six months of scheduled appointments. The appointment system for tuberculosis is paper based but the majority of patients have access to a mobile phone.

The Nimtone pilot reduces missed appointments

Nimtone is a web app that allows the clinic to send automated text messages to their patients about upcoming appointments and alerts them about missed appointments. The clinicians are able to use the system to update information about patients and can slowly review daily activities like appointments scheduled that day. The app’s pilot program ran from October to November 2013, with 300 TB patients. Over the two month period, the rate of missed appointments dropped by 50% and there were zero reports of missed ongoing appointments.

The text messages proved even more beneficial than expected. Patients said they were able to provide legitimate proof of a medical appointment to leave work. One patient who depended on his wife to remind him to pick up medicine, was able to keep his treatment consistent while she was away. The numbers showed the pilot was a success and a final survey bolstered that fact. 98% of patients reported they wanted to continue getting the message reminders. The clinic is continuing to provide the service.

Expanding to reach more people in need

Following the pilot project, the clinic will be expanding the program from 300 patients to 1,300 HIV positive children, adolescents and adult patients whose HIV treatment may no longer be working for them. The app itself is currently being upgraded to be rolled out to MSF projects across the world – MSF provides medical humanitarian assistance in 71 countries with almost 32,000 staff on board.

In resource-poor settings the text messaging provides a communication channel that is accessible. The team is thinking about adapting to use with other patient groups and IT systems for patient management. Because the app is open source and license free, any medical group can utilize the tool.

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